2021 MIPS Measure #265: Biopsy Follow-Up

Measure Description

Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient.

Instructions

This measure is to be submitted once per performance period for patients who are seen for an office visit and have a biopsy performed during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: While this measure is only required to be submitted once per eligible patient per performance period, it is recommended that the MIPS eligible clinician performing the biopsy communicates the results to the primary care/referring physician and patient each time a biopsy is done.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

All patients undergoing a biopsy

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs. Only biopsy results should be reported for this measure. Do not include specimens sent for debridement.

Denominator Criteria (Eligible Cases):

All patients regardless of age on date of encounter

AND

Patient procedure during the performance period (CPT): 11102, 11104, 11106, 11755, 19081, 19083, 19085, 19100, 19101, 19125, 20200, 20205, 20206, 20220, 20225, 20240, 20245, 20250, 20251, 21550, 21920, 21925, 23065, 23066, 23100, 23101, 24065, 24066, 24100, 24101, 25065, 25066, 25100, 25101, 26100, 26105, 26110, 27040, 27041, 27050, 27052, 27323, 27324, 27330, 27331, 27613, 27614, 27620, 28050, 28052, 28054, 29800, 29805, 29830, 29840, 29860, 29870, 29900, 30100, 31050, 31051, 31237, 31510, 31535, 31536, 31576, 31625, 31628, 31629, 31717, 32096, 32097, 32098, 32400, 32604, 32606, 32607, 32608, 32609, 37200, 37609, 38221, 38500, 38505, 38510, 38520, 38525, 38530, 38570, 38572, 40490, 40808, 41100, 41105, 41108, 42100, 42400, 42405, 42800, 42804, 42806, 43193, 43197, 43198, 43202, 43239, 43261, 43605, 44010, 44020, 44025, 44100, 44322, 44361, 44377, 44382, 44386, 44389, 45100, 45305, 45331, 45380, 45392, 46606, 47000, 47100, 47553, 48100, 48102, 49000, 49010, 49180, 49321, 50200, 50205, 50555, 50557, 50574, 50576, 50955, 50957, 50974, 50976, 52007, 52204, 52224, 52250, 52354, 53200, 54100, 54105, 54500, 54505, 54800, 54865, 55700, 55705, 55706, 55812, 55842, 55862, 56605, 56821, 57100, 57105, 57421, 57454, 57455, 57460, 57500, 57520, 58100, 58558, 58900, 59015, 60100, 60540, 60545, 60650, 61140, 61575, 61576, 61750, 61751, 62269, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 64795, 65410, 67346, 67400, 67450, 67810, 68100, 68510, 68525, 69100, 69105, 75970, 93505

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Numerator

Patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and the patient by the provider and/or office and medical team. There must also be acknowledgement and/or documentation of the communication in a biopsy tracking log and document in the patient’s medical record.

Numerator Instructions: To satisfy this measure, the biopsying physician and/or office and medical team must:

• Review the biopsy results with the patient
• Communicate those results to the primary care/referring physician
• Track communication in a log
• Document tracking process in the patient’s medical record

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient reason(s) for not communicating the results to the Primary Care or referring physician (e.g. patient self-referred or has no Primary Care Physician, etc.) as further specified below.

Definition:

Communication – Acceptable communication methods which are to be documented in the biopsy tracking log and patient medical record include:

• Directly speaking with the patient or a person designated by the patient to discuss biopsy results
• Documented telephone message or voice mail regarding the availability of biopsy results
• Mailer/fax sent to the patient indicating the availability of biopsy results or discussing the diagnosis itself
• Any HIPAA secure electronic communication with the patient discussing the biopsy results

The components of a tracking log incorporate the following-

• Initials of physician performing the biopsy
• Patient name
• Date of biopsy
• Type of biopsy
• Biopsy result
• Date of biopsy result

Numerator Options:

Performance Met:

Biopsy results reviewed, communicated, tracked, and documented (G8883)

OR

Denominator Exception:

Clinician documented reason that patient’s biopsy results were not reviewed, [e.g., patient asks that biopsy results not be communicated to the primary care/referring physician, patient does not have a primary care/referring physician or is a self-referred patient] (G8884)

OR

Performance Not Met: Biopsy results not reviewed, communicated, tracked, or documented (G8885)